Convenience and quality

A middle age man from a town far away came to our department with acute pain to rule out urinary calculus. During routine questioning, we noted that he has just taken his meal mere hours ago. By right, we routinely prep the bowels and fast the patients prior to IVU prior to the study. But in this case, we need to make the exception in view of the logistic reason and the urgency of the case. Shown in the image above is the preliminary film with calculi in the right urinary system. As the preliminary film shows not much of bowel gas, the study was proceeded.


Unfortunately as the study progressed, the bowel gas just kept on increasing to the extent that it almost obscure the view. Fortunately fast bolus injection of pre-warmed contrast was given, hence the concentration of the contrast excreted into the urinary system was sufficient to enable visualization of the urinary tracts beyond the bowel gas.

The lesson learnt in this case is the importance of fasting. Non-fasting patient can have increasing bowel gas which may obscure the opacified urinary tracts. It may not be justifiable to sacrifice quality for convenience. But when it comes to answering important clinical questions, exceptions may need to be made, as per this case.